Electroconvulsive therapy (ECT) can be lifesaving for patients suffering from treatment-resistant psychiatric conditions, especially acute suicidality or depression. However, space-occupying lesions pose risks associated with ECT use due in part to seizure-induced escalations in blood pressure with corresponding increases in cerebral blood flow and possibly intracranial pressure, subsequently increasing the risk of brain herniation. Here, we present the case of a patient with a left medial temporal lobe astrocytoma, worsening epileptic seizures, and nonepileptic seizures who underwent ECT for major depressive disorder and suicidality. The patient had improvement of depressive symptoms, resolution of suicidality, and brief cessation of nonepileptic seizures. Brief anterograde amnesia contributed to the termination of treatment. This case adds to the growing literature about the feasibility of ECT treatment in cerebral lesions prone to changes in intracranial pressure, such as the usually cystic astrocytomas.Electroconvulsive therapy (ECT) is controversial in children and adolescents (C/A). The primary objective of this study was to evaluate baseline characteristics of C/A in the utilization of ECT compared with the non-ECT group with the same primary indication. The secondary objective was to assess the trends in ECT utilization over 16 years and explore the predictors of length of stay.
Using the Nationwide Inpatient Sample database from the years 2002 to 2017, we identified patients (age ?18 years) undergoing ECT in the United States using International Classification of Diseases, Ninth Revision and Tenth Revision, Clinical Modification/Procedure Coding System codes and compared with non-ECT C/A patients with the same primary diagnosis. Baseline clinical characteristics were assessed using descriptive analysis methods. Multilevel regression analysis and trend analysis were performed.
Children and adolescent patients (n = 159,158) receiving (ECT n = 1870) were more likely to be men (43.3% vs 36.7%) and of White race (58% vs 49%) (P &lt; 0.001). The hospital stay was longer (19 days vs 6 days, P &lt; 0.001) for the ECT group than controls. ECT receiving C/A patients were more likely to have private insurance (72% vs 42%, P &lt; 0.001). African American patients undergoing ECT treatment increased in number over the course of years (2002 to 2017), whereas the privately insured C/A patients receiving ECT decreased over the same period (P &lt; 0.001). There was an upward trend in ECT utilization for small bed size hospitals (P &lt; 0.001). Length of stay for C/A receiving ECT was longer for males (P &lt; 0.001) and patients with nonprivate insurance (p 0.003).
Electroconvulsive therapy is not optimally used in C/A; therefore, formulated treatment guidelines are required.
Electroconvulsive therapy is not optimally used in C/A; therefore, formulated treatment guidelines are required.Through unfolding patient case studies, case-based learning has the potential to facilitate nurse practitioner (NP) student application of didactic knowledge to clinical practice, thus narrowing the theory-practice gap. The purpose of this study was to investigate NP student experience using virtual patient cases to supplement clinical learning. Bloom's cognitive taxonomy served as the framework. Seven students enrolled in the final semester of a distance family NP program completed 45 virtual patient cases over an 8-week period. Case topics covered a variety of primary care problems. Usability of the virtual learning platform was measured by the System Usability Scale. Clinical learning value was measured by the Student Satisfaction and Self-Confidence in Learning Scale. Students rated their perceived ability to manage common primary care problems at the start and end of the 8-week period. Students found the virtual learning platform highly usable and were satisfied and self-confident with their learning. of the virtual learning platform was measured by the System Usability Scale. Clinical learning value was measured by the Student Satisfaction and Self-Confidence in Learning Scale. Students rated their perceived ability to manage common primary care problems at the start and end of the 8-week period. Students found the virtual learning platform highly usable and were satisfied and self-confident with their learning. Student perceived ability to manage common primary care problems increased for all virtual case topics from start to end of course. This study provides further evidence that well-designed virtual patient cases have the potential to effectively supplement NP student clinical learning. These results are important as NP faculty look for alternative forms of clinical learning to supplement direct care clinical experiences.Current palliative care workforce projections indicate that the growing palliative care needs of older adults in US nursing homes cannot be met by specialists, leaving them vulnerable and at risk for poor end-of-life outcomes. The purpose of this article is to describe the development, implementation, and initial evaluation of a program to support primary care nursing home nurse practitioners (NPs) in palliative care. The program aimed to improve geriatric NPs' knowledge and skills related to palliative care and to provide a structured protocol for integrating palliative care encounters into NPs' practice. It comprised three phases consisting of asynchronous online learning modules, a 1-day face-to-face communication skills and patient simulation workshop, and ongoing monthly virtual meetings to support NP clinical practice. Over a 1-year period, the program was developed and implemented with 12 practicing NPs in a national organization. Through an online survey and face-to-face feedback, NPs reported satisvirtual meetings to support NP clinical practice. Over a 1-year period, the program was developed and implemented with 12 practicing NPs in a national organization. https://www.selleckchem.com/products/daratumumab.html Through an online survey and face-to-face feedback, NPs reported satisfaction with the curriculum and expressed it as valuable to their clinical practice. Future work will focus on sustaining implementation of the program, measuring patient level outcomes, and refining the curriculum based on NP feedback.